Comparison of sevoflurane and propofol for ambulatory anaesthesia in gynaecological surgery

Abstract

Purpose: To analyse the cost-efficiency ratio of sevoflurane compared with propofol for gynaecological ambulatory anaesthesia. Methods: In a prospective randomised study 52 ASA I patients scheduled for ambulatory pregnancy termination were premedicated with lorazepam and received alfentanil prior to anaesthesia induction with propofol (group P, n = 26) or with sevoflurane 8% (group S, n = 26) using the single breath vital capacity technique. Anaesthesia was maintained with N20 in both groups supplemented with sevoflurane (group S) or propofol boluses (group P). l~,~dts: The quality of induction and maintenance of anaesthesia was similar between groups except for the incidence of movement during anaesthesia (14126 patients in group P and 4/26 in group S, P < 0,05). The incidence of post-operative emesis was increased in the sevoflurane group (P < 0.05) but the patients felt able to perform normal activity after a similar delay (I 8.4 __. 2.9 hr vs 20.6 ---2.8 hr, P > 0,05). The direct cost of anaesthesia was lower in the sevoflurane group (679 FF, n = 24 vs I 153 FF, n = 2-5 in propofol group) but the weight of uterine aspiration products was higher (293 _+_ 66 g, median = 230 g, Range I 10-800 g, n = 13 vs 108 ---8 g, median = I I 0 g, Range 60-160 g, n = 12, group S vs group P respectively, m = 0.004). Four patients needed reoperation and ambulatory anaesthesia failed in six patients because of uterine haemorrhage. Conclusion: Ambulatory anaesthesia with sevoflurane offers a good alternative to propofol but further investigation concerning blood loss with sevoflurane needs to be performed in gynaecological practice.Objecl~ : Cette &ude prospective randomis6e compare le rapport coOt efficacit6 du s~voflurane et du propofol pour ranesth6sie ambulatoire gyn~cologique. M&hodes : Cinquante deux patientes class~es ASA I, devant subir une interruption volontaire de grossesse par aspiration ont re(ju une pr~m6dication avec du lorazEpam et ont regu de l'alfentanil avant une induction soit intraveineuse, avec du propofol (groupe P, n = 26) soit par technique de capacit6 vitale avec 8 % de s~voflurane (groupe S, n = 26). l'anesth&ie a &~ maintenue avec du N20 associ~ ~ du s6voflurane (group S) ou ~ des bolus r~pEt& de propofol (group P). ~.sultats : La qualitE de rinduction et rentretien de l'anesthEsie ont &E similaires entre les 2 groupes sacque pendant ranesth~sie, 14/26 des patients du groupe Pont boug~ et seulement 4/26 darts le groupe S (P < 0,0S). l'incidence des naus6es postop6ratoires a Et~ sup&ieure dans le groupe S mais le retour ~ une activitE normale a connu un d~lai similaire dans les deux groupes (18,4 _-_ 2,9 h vs 20,6 ---2,8 h, P > 0,05). Le coOt direct de l'anesthEsie avec le sEvoflurane a ~t~ infEdeur (679 FF, n = 24 vs I 153 FF, n = 25 darts le groupe propofol) mais le poids des produits d'aspiration ut&ine a ~t~ sup~deur (293 ___ 66, g, mEdiane 230 g, limites 110-800 g n = 13 clans le groupe S vs 108 +-8 g, m~diane I I 0 g, limites 60-160 g n = 12 dans le groupe P, P = 0,004). Quatre patientes du grou...

Sevoflurane for interventional neuroradiology procedures is associated with more rapid early recovery than propofol

“…Similarly, the absence of a difference in nausea and vomiting scores might be expected after procedures that are not commonly associated with postoperative nausea and vomiting (PONV). Although some researchers have reported an increase in PONV associated with sevoflurane use, 11,12 others have found no difference. 8,9 Use of an anesthesia technique without the concomitant use of long-acting opioids may have contributed to the overall low rate of PONV in this study.…”

Prevention of nausea and vomiting during termination of pregnancy

“…They belong to the butyrophenone, benzamide, antihistamine, anticholinergic, glucocorticoid, or serotonin receptor antagonist classes [2,3,[8][9][10][11][12][13][14][15][16][17][18]. After reviewing the risk factors for PONV, we reviewed and assessed the efficacy of the drugs used in women undergoing dilatation and curettage under general anesthesia for elective or therapeutic termination of pregnancy.…”

Nitrous Oxide Does Not Aggravate Postoperative Emesis After Orthognathic Surgery in Female and Nonsmoking Patients

“…Propofol and sevoflurane are good candidates as an anesthetic because of their rapid emergence profile. [1][2][3][4][5][6] Postoperative vomiting is another risk factor for postoperative airway obstruction, especially in patients under intermaxillary fixation. Some anesthetics such as nitrous oxide and volatile anesthetics including sevoflurane, supplemental agents such as opioids, neostigmine, female patient, nonsmoking status and a history of postoperative nausea and vomiting (PONV) are risk factors for PONV.…”